Eli's Rehab Report

Published on Fri Sep 26, 2014 PDF

You might have to avoid the 97000 series altogether.

While Medicare may not cover telehealth services (yet), many states have telehealth parity acts in place, requiring private insurers to pay for them. Be sure you know how to properly recoup eligible reimbursement for telehealth sessions of the sort.

“AOTA believes that the same CPT® codes would be used, but some payers may require a modifier to indicate that the services were provided via telehealth,” says Chuck Willmarth, director of health policy and state affairs for the American Occupational Therapy Association (AOTA).

Modifier GT, specifically, is for noting approved telehealth services. “For example, private insurer CareFirst, which is the BCBS provider for the Mid-Atlantic area, does reimburse for speech language pathology telehealth, and they have programmed their systems to accept those codes with a modifier,” says Janet Brown, MA CCC-SLP, director of health care services in SLP for the American Speech-Language Hearing Association (ASHA). 

But don’t jump straight to the modifier without talking to your payer directly and verifying the fine print.

Example: “Many of the traditional codes (97000 series) specify ‘direct one-on-one patient contact,” which by strict definition would exclude telehealth services unless the payer has agreed to include these services,” notes Gayle Lee, senior director of health finance and quality for the American Physical Therapy Association (APTA).  

If you’ve dead-ended in the 97000 series and think you found your ticket in the relatively new telephone and online medical evaluation codes that were added to CPT® several years ago (98966-98969), proceed with caution. Medicare does not cover these codes, and it’s a slim chance that private payers do.

Bottom line: Even though Medicare coverage for telehealth services is limited to nil in rehab, some payers may be on board, and you don’t want to miss out on those reimbursable dollars — but you also don’t want to be slammed with denials.

And remember, just because a telehealth service is not reimbursable doesn’t mean you can’t provide the service. You may be surprised to find a patient willing to pay out of pocket in order to receive therapy from the comfort of their home.